Nigeria is lagging behind in the provision of antiretroviral (ARV) treatment for people living with HIV/AIDS, and only one out of five people who need the drugs have access to them, according to a new study.
Nigeria has a five-year plan to scale up ARV therapy, aimed at providing one million people with the life-prolonging treatment by 2009, but there are indications that it may not meet that target unless the government provides substantially more resources. An earlier target of providing 250,000 people with treatment by 2006 has already been missed.
The study, by the Health Reform Foundation of Nigeria (HERFON), a non-governmental organisation, revealed that only about 124,572 adults and 5,279 children of the 555,000 Nigerians estimated to be in need of ARVs were receiving them by March 2007.
Although the figure represented a ten-fold increase in the number of people on ARVs compared to 2002, HERFON said the level of access was still unacceptably low.
The survey results, released last week in Abuja, the capital, involved on-the-spot assessments of 14 ARV delivery sites and five HIV counselling and testing centres across the country. The findings support calls by activists for greater commitment by government and other stakeholders to check the spread of the virus in Nigeria by making treatment more available.
"We have always known that many people, especially those in the rural areas, cannot access ARVs. Even in the urban centres, some have to travel long distances at great cost to get treatment," said Fredrick Adegboye, a journalist living with HIV.
HIV has spread steadily in Nigeria: less than two percent of the population were infected with the virus in 1991, but the number is now thought to be more than five percent of the country's 126 million people.
The report attributed the failure to meet treatment targets to the nation's poor health system and insufficient funding for treatment programmes, which often put access to treatment beyond the reach of ordinary people.
"The monthly income of four in every five (76%) of this working population was about N30,000 ($250) with a burden of average monthly expenses of N55,000 ($433). This was found to be a major obstacle to patient attendance at follow up clinics and adherence to their drug combination," the investigators pointed out.
Despite the government's expressions of commitment to providing treatment for HIV-positive people, the country's ARV therapy response was still largely donor-driven.
"Most of the funds for the ART [antiretroviral therapy] programme are coming from development partners. This is a major challenge, especially as present financing from the federal [Nigerian] government accounts for less than five percent of the PLWHA [People Living with HIV/AIDS] on ART," the report commented. "State and local governments are hardly making any contributions, even though most of the activities take place at these levels."
The study also noted different standards of affordable care at sites supported by development partners, compared to those that were fully funded by government.
"At most government sites, the only free service was the cost of antiretroviral drugs. Patients had to pay for the costs of laboratory monitoring, treatment of opportunistic infections and other indirect costs [travel to and from clinics and accommodation while waiting to attend clinics], while at sites supported by implementing partners, patients only bear indirect costs."
More than 80 percent of patients were receiving combinations of ARV drugs that included stavudine, a first-line drug that has been associated with a number of unpleasant side effects. The World Health Organisation has recommended replacing stavudine with less toxic, tenofovir-based drugs, which are significantly more expensive.
Government sites also did not stock second-line drugs for patients experiencing treatment failure on first-line drug combinations.
The study found that while about 80 percent of people received adequate counselling before starting ARVs and understood how to prevent transmitting the virus to sexual partners, more than half (53 percent) continued to practice unsafe sex.
Prof John Idoko, the principal investigator, said there was an urgent need to upgrade facilities, equipment and supplies, and increase investment in the recruitment and training of staff at public and private facilities delivering ARV treatment.
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